The seventh congress of the

European Association of Dental Public Health13-14th September, 2002, Athens, Greece

Topics

Behavioural Sciences / Health Services ResearchCariology ResearchDiagnostic SystemsGeriatric Oral ResearchOral & Dental HygienePeriodontal Research: Diagnosis / EpidemiologyEpidemiologyCaries PreventionOther

Behavioural Sciences/Health ServicesResearch

Determinants of productive efficiency in Finnish PublicDental Service

E WIDSTRÖM*, M LINNA, T NISKANEN

National Research and Development Centre for Welfare and Health (STAKES), Helsinki,Finland.

The aim of this study was to investigate the determinants of cost efficiency in the Public DentalService (PDS), which, when the study was performed, was responsible for most dental care forthe population 40 years and younger. Personnel and material costs were used as input andnumbers of treated patients in 3 different age groups as output variables. Economic TOBITanalysis was used to explore various predictors of cost efficiency (CE), technical efficiency (TE)and allocative efficiency (AE).

According to our results the most important determinants of CE and AE were state subsidylevels, socioeconomic conditions of the municipality, treatment patterns and the emphasis ontreatment of children and youngsters. High state subsidy, high number of visits per person andhigh proportion of 0 to 18-year-olds among the patients predicted inefficiency. Lowsocioeconomic conditions in the municipality predicted efficiency. The results indicate that localmunicipalities have failed to reallocate their resources according to the rapid improvement ofdental health in young patients. It is also obvious that generous state subsidies weakenincentives for cost control locally. Many PDS units could have enhanced allocative efficiency byallocating their personnel resources more optimally. Conclusions: Many PDS units seemed tounderperform. It is a big health political challenge to improve the productive efficiency ofPDS.

Self-care in oral health among Danish adults, 2001

LB CHRISTENSEN*, PE PETERSEN

University of Copenhagen, Faculty of Health Sciences, Dept. for Community Dentistry,Denmark.

The oral health care services for adults in Denmark include preventive dental care wherebypatients are encouraged to adapt oral self-care practices. The purpose of the present reportwas to describe the oral self-care habits among adults and to analyse oral self-care habits inrelation to gender, age, oral health status, utilisation of the oral health services, and socio-economic conditions. A total of 7000 citizens 16 years or more were randomly selected. Theresponse rate was 64%, and the final study population comprised 3858 dentate persons. Dataon oral self-care were collected by postal questionnaires and other data were derived frompersonal interviews. Bivariate analysis and multivariate logistic regression were used for dataanalysis. Toothbrushing more than once a day was reported by 68%; 70% used toothpicks and46% used dental floss. However, use of toothpicks or dental floss at least once a day wasreported by 28% and 11% accordingly. Self-care practices in oral health were more frequentamong women than men for all age groups (P<0.001). Toothbrushing more than once a daywas related to regular dental visits (P<0.001), 10 teeth or more (P<0.001), regular dental carethroughout school years (P<0.001), and high level of education (P<0.001). Predictors for use oftoothpicks were 10 teeth or more (P<0.001), regular dental visits (P<0.001) and high level ofhousehold income (P<0.001). The level of self-care in oral health varied significantly bysocio-demographic factors and use of oral health services in adult life and childhood.The future challenge to the dental profession is to target oral health education towardsthose persons in need. The study was supported by Danish Health Insurance Research Fund.

Market price of service mixes in free public dental care

SKJ HELMINEN(1)*, MM VEHKALAHTI(2)

1 Helsinki City Health Department2 Institute of Dentistry, University of Helsinki, Finland.

The objective of this study was to compare the number of dental visits to free public dental careand the market price of service mixes in Helsinki public dental care. In Finland in 1999, all under19 years of age were entitled to free public dental care. In Helsinki, altogether 67 309 suchpatients visited a public dental clinic in 1999, 47 826 receiving comprehensive dental care. Datawere taken from ADP files recorded by patient and visit. Each item of treatment has an individualcode showing the type of service. Market prices for service mixes were obtained from thestatistics on private dental care in Helsinki, provided by the consumer authorities. Median pricefor each item of service was used. Mean number of visits among 0- to 5-year-olds was 1.4 (SD1.1), among 6- to 15-year olds 3.7 (SD 3.5) and among 16- to 18-year-olds 3.0 (SD 2.7),respectively. Orthodontic treatment was given to 18 per cent of all 0- to 18-year-old patients,and every fourth dental treatment given to 6- to 15-year-olds involved orthodontics. Patientswith orthodontic treatments (ORT) made 7.2 visits compared to 2.2 for those with noorthodontics (NORT) group. The average market price of all treatments per patient was 49.7 €for 0- to 5-year-olds, 170.2 € for 6- to 15-years-olds, and 155.5 € for 16- to 18-year-olds. Theaverage market price for all dental treatments was 289.5 € per patient in the ORT group and105.9 € in the NORT group. The comparatively larger proportion of orthodontic treatmentsmay well account for the high market price per patient of services given to 6- to 15-year-

may well account for the high market price per patient of services given to 6- to 15-year-olds. A grant by the Helsinki City Health Department to SKJ.H. is highly appreciated.

Optimum fluoride concentration in water supply in Rio deJaneiro City

NM MORAES, SG HARARI*, ND HARARI

Department of Preventive Dentistry, Friedrich-Schiller-University of Jena, Germany; Departmentof Community Dentistry, Federal University of Rio de Janeiro, Brazil.

It is well established by the dental literature that optimum fluoride concentration in the watersupply is a recognised preventive method against caries disease lesions. In spite of this methodhas been recommended for many years in Brazil, it seems that there is not an effective controlover its utilization in this country. Objective: The aim of the present study was to quantify thefluoride concentration in the water supply of the different regions of Rio de Janeiro city. Materialand methods: The water samples were collected from 9 regions of the city during 6 months toevaluate the real situation of this important method of health promotion. Results: The mediumvalue of fluoride concentration was was only 0,21 ppm. Conclusion: The results show that thefluoride concentration has been insufficient for caries prevention and that intensive work shouldbe implemented by the local authorities.

Refusal of treatments recommended for adults in publicand private dental care in Finland

M HEINIKAINEN*, MM VEHKALAHTI, H MURTOMAA

Institute of Dentistry, Department of Oral Public Health, University of Helsinki, Finland.

The present study assessed adult patients' refusal of recommended treatments and reasons forrefusal in the public and private sectors in Finland. The numbers of dentists working in bothsectors are approximately equal, private dentists working mainly with adults. A postalquestionnaire was mailed to general practitioners (n=400) selected by stratified randomi-sationamong members of the Finnish Dental Association. The sample was restricted by gender, age(30-39 and 40-49), and main occupation (public or private sector). The response rate was 77%,from 146 private dentists and 165 public-sector dentists. The dentists were asked to report themost recent refusal of recommended treatment, such as fixed prosthetic restoration, removableprosthesis, implant therapy, periodontal treatment, extraction or surgery on a tooth, restorativetreatment, endodontic treatment, or radiograph. Further, reasons for refusal were separatelydetermined, the alternatives being high cost, dental fear, no perceived need, long treatmenttime, and others. Statistical evaluation was made by the Chi-square test. The refusal mostfrequently reported was related to fixed prosthetics (25%), followed by extraction or surgery ontooth (23%), implant therapy (13%), and removable prosthesis (11%). Compared to publicsector dentists, private dentists reported more frequent refusal of fixed prosthetics (30% vs.19%, p=0.04), but less frequent refusal of extraction or surgery on tooth (29% vs. 18%, P=0.03).The reason most frequently reported for refusal was high cost (45%), followed by no perceivedneed (30%), and dental fear (16%). The refusals most frequently reported were related toprosthetic treatments, the reason mainly being high cost. Financial support by The FinnishDental Society Apollonia and co-operation of the Finnish Dental Association are gratefullyacknowledged.

acknowledged.

Service-mix in free public dental care for 6- to 15-year-oldsin Helsinki, Finland.

MM VEHKALAHTI(1)*, SKJ HELMINEN(2)

1 Institute of Dentistry, University of Helsinki, Finland2 Helsinki City Health Department, Helsinki, Finland.

The present study evaluated the quantity and content of free public dental care for 6- to 15-year-olds in Helsinki, Finland. In Finland, the public oral health service provides all dental carefree of charge for all under 18 years of age. Participation is almost 100% at ages 6 to 15.Comprehensive dental care (CDC) is the main line of the service including regular dental check-ups at individual recall intervals followed by all treatments needed. Between treatment coursespatients may receive supplementary dental care (SDC) due to acute problems or to continuewith treatments, previously started, e.g., intensified caries prevention or orthodontics. Annualdata on services and oral health indices are recorded in ADP files by patient and by visit, with anindividual code for each item of service. Indices of DMFT and DT+dt are recorded in CDC, butnever in SDC. In 1999, a total of 43,850 patients aged 6 to 15 had been treated, 77% were inCDC, their mean DMFT index being 1.1 and mean DT+dt 0.6. All patients made, on average,3.7 visits (SD 3.5; max 28), with no difference seen in CDC and SDC patients. Orthodonticsinvolved 25% of all patients, 23% in CDC, and 34% in SDC (P=0.000). Correspondingly,sealants were placed in 26% and 21% (P=0.000) of patients, but any other caries preventionwas given similarly (29%) to CDC and to SDC patients. Fillings were made in 35% of those inCDC, and in 20% of those in SDC. Mean number of fillings placed was 0.8 in CDC and 0.4 inSDC, and of orthodontic treatments 1.6 and 2.8. Despite the full coverage of CDC duringschool age, one-fourth of the patients received SDC, the service-mix being dominated byorthodontics but not by intensified caries prevention. A grant by Helsinki City HealthDepartment to SH is gratefully acknowledged.

The trends of toothbrushing habits of Finnish adolescentsfrom 1977 to 2001

E HONKALA(1), S HONKALA(1)*, A RIMPELÄ(2), L PERE(2), LKOIVUSILTA2, M RIMPELÄ(2)

1 Faculty of Dentistry, Kuwait University, Kuwait2 School of Public Health, University of Tampere, Finland.

The aim of this study was to find out the trends of toothbrushing habit among the Finnishadolescents between 1977 and 2001. For decades twice a day toothbrushing habit has beenrecommended by the dental and general health care personnel in their health education. TheAdolescent Health and Lifestyle Survey is based on self-administered questionnaires mailed toa respresentative sample of 12-, 14-, 16-, and 18-year-old Finns every second year since 1977.The sample sizes in the surveys have varied from 2,422 to 11,105, making a total of 77,230subjects in this entire study. Toothbrushing frequency has been asked in every survey. Twice aday toothbrushing seemed to increase quite consistently, but slowly over this 24-year periodamong boys. This increase was only 5-6% among 12-, 16-, and 18-year-old boys and 10%among 14-year-old boys. Among girls the proportions of recommended brushing increased from

among 14-year-old boys. Among girls the proportions of recommended brushing increased from1977 to 1979 among 12-year-olds, to 1981 among 14-year-olds, to 1983 among 16-year-olds,and to 1985 among 18-year-olds, but decreased since then among 16-year-olds by 14% andamong 18-year-olds by 16%. There has been a slight increase in proportions of subjects withrecommended toothbrushing in all regions, except in the Northern Finland. The differencebetween capital and the rural areas has stayed consistent. The children of less educatedparents have slightly improved their brushing, but the children of well educated parentsdeteriorated their brushing. It may be concluded that there has been small progress intoothbrushing habit reported of Finnish boys, but only 20-30% of them are still brushingaccording to recommendation. Among girls there has been a consistent declining trend. There isstill much to do in establishing appropriate toothbrushing habits among the Finnish adolescents.

Dental anxiety, caries and parental dental anxiety amongFinnish children

S LAHTI*, K RANTAVUORI, L SEPPÄ, S KÄRKKÄINEN, H HAUSEN

Institute of Dentistry, University of Oulu, Finland.

Our aim was to study children's dental anxiety in relation to their caries status and parentaldental anxiety. Independent random samples of all children aged 3, 6, 9, 12 and 15 years weredrawn in the towns of Kuopio and Jyväskylä in 1998. The sample included 180 children fromeach age group in both towns. Caries was registered clinically and radiographically by calibrateddentists. Children's and their parents' dental anxiety were measured with a single 5-point Likert-scale question. DMFS and dmfs were dichotomized as 0=caries-free, 1=one or more cariouslesions. The numbers of children included in the final analysis were 290 (3 yrs), 302 (6 yrs), 299(9 yrs), 314 (12 yrs) and 297 (15 yrs) with the total response rate being 83%. The percentage ofchildren who reported to be somewhat, fairly or very anxious were 33, 28, 16, 13 and 13%, ineach age group, respectively. Of the dentally anxious children among 6-, 9-, 12- and 15-year-olds, 89, 83, 64 and 82% reported to be afraid of pain, respectively. The respective percentagesof children being afraid of drilling were 68, 71, 57 and 64%. Only among 3-year-olds, childrenwith dental anxiety had caries more often than children reporting no anxiety (c2=4.67, P=0.044).Children whose parents reported being dentally anxious were consistently more often anxiousthan children whose parents reported no dental anxiety (c2=10.88, P=0.002 for father's anxietyand c2=8.30, P=0.006 for mother's anxiety when all the data were pooled). In general,children's dental anxiety was associated with their parents' dental anxiety but not withtheir own dental caries status. This study was supported by the Yrjö Jahnsson Foundation.

Dentist managed intervention program to reduce ETSexposure during infancy

M GYENES*, M HOVELL, J BANOCZY

Department of Preventive and Paediatric Dentistry Karolina Hospital, Mosonmagyarovar, Centerfor Behavioral Epidemiology and Community Health, San Diego State, USA, UniversityDepartment of Oral Biology, Semmelweis University, Hungary.

The aim of the study was to demonstrate the effectiveness of dental practitioners in Hungary inimplementing techniques previously tested in San Diego, California to help patient families inreducing children's environmental tobacco smoke (ETS) exposure and quitting smoking. The

reducing children's environmental tobacco smoke (ETS) exposure and quitting smoking. Theobjectives of this study were: 1) To determine whether counseling provided by midwifes ingeneral pediatric and general dental practices reduces ETS exposure compared to controlfamilies, as measured by parent reports and children's urine nicotinine analyses, 2) Todetermine the differential effects of the intervention as measured by the proportion of motherswho quit smoking compared to control families, 3) To determine the differential effects of theintervention and control procedures on environmental nicotine levels in participants' homes. Theintervention group received eight behavioral counseling sessions over three months. Counselingwas directed to the mothers, and other parents/smokers living in the home were encouraged toparticipate. Counseling incorporated behavioral contracting, shaping, and problem-solvingnegotiations, and motivational enhancement strategies for smoking cessation. Outcomemeasures were obtained at baseline, 3- and 6 months. Measures included a detailed interviewconcerning smoking and ETS exposure rates, key Social Learning Theory variables, andchildren's health care utilisation. Children's urine samples were analysed for cotinine. Self-reported smoking cessation was verified with cotinine analysis. A longitudinal two-groupsexperimental design used by mothers with a child from two to eight years exposed to theirmother's tobacco smoke at home will be recruited to participate in the study. Families withinoffices were assigned (30/group) at random to: 1) usual medical care control plus advice fromthe dentist to quit smoking and to smoke only outside the home to protect their children fromETS exposure, 2) midwifes/dental hygienist counseling for smoking cessation and reduction ofthe child's exposure to ETS. Urine samples were obtained at interview by the dental intern. Ifmothers or other family members quited smoking, we asked to give saliva or urine samples toverify. The preliminary results demonstrate efficacy. Thus this model could be good forexpanding ETS/cessation services in dental offices throughout Hungary.

Dental Nurse workforce and training needs in GeneralDental Practice

C ALLEN*

West Kent Health Authority, Aylesford, Kent, UK.

The objectives of this study were to identify the Dental Nurse workforce in Kent and their trainingrequirements. At present Dental Nurses in the UK do not have to be qualified or registered so itis difficult to assess the size of the workforce. By 2004 this will change with a Dental NurseRegister being held by the General Dental Council. New Dental Nurses entering the register willhave to be qualified and there will be an expectation for all nurses to take part in ContinuingProfessional Development(CPD). A questionnaire was sent to all dental practices in Kent askingfor details of their dental Nurses' qualifications, recruitment and training. Following a reminder,the response was 72% (n=194). From the responses, there were 702 nurses employed,representing 615 whole time equivalents. 44% had a Dental Nurse qualification and 67% ofpractices expected their unqualified Dental Nurses to take the National exam. Only 20% ofrespondents stated having a problem with staff turnover but 53% of nurses left within four years.49% had difficulty with recruitment, 39% having advertised three or more times. Two thirds saidthis was due to difficulties in finding the right person rather than enough people applying, withhalf taking more than two months to fill a vacancy. Whilst 54% stated their Dental Nursesattended a course in the last year, mostly this was the free, practice based, basic life supportcourse offered by the Health Authority or a course leading to the National Examination forDental Nurses. However, 82% of respondents said they would be willing to give paid leave fortheir nurses to attend a course. When asked about courses, 67% wished to see trainingavailable for the National Certificate in Dental Nursing and 64% for communication skills. Thereappears to be an unmet need for training and CPD for Dental Nurses in Kent.

Identifying areas with populations at higher risk for oraldisease

K ARONSSON, S ORDELL*

Centre for Public Health Sciences, Linköping, Sweden.

Objective Can a Geographical Information System (GIS) be used to identify areas withpopulations at higher risk for oral disease? Background To target health-promoting programs,groups that are at higher risk of developing disease must be identified in a cost-effectivemanner. Other studies have shown that administrative areas can be used to identify suchpopulations. Data on socio-economic status (SES) had been compiled in a GIS matrix whereindividuals are identified according to their adresses of residence. Methods The SES data wassupplied by the National Bureau of Statistics and the population grouped according to acomposite index, which was calculated for each of the 940 areas in the county of Östergötland(population 420 000). These were fitted in the GIS matrix and used to group the SES areas infive clusters. The routinely collected data on dental caries supplied by the Public Dental HealthService (PDHS) for all 6 and 19 years old were fitted for each individual into the GIS matrix. Inall eight sets of caries data were used. The SES index and the caries data were comparedusing Pearssons chi-square test. Results Data on healthy oral conditions and on severedisease had a close and stepwise correlation to the SES clusters identified in the GIS. Healthyindividuals were 50% more common in the best cluster compared with the worst. Individualswith severe disease were two to three times more common in the worst compared to the bestclusters. The differences were significant for each cluster compared with all the others together.Conclusion SES data as composed in the SES index is a useful tool in identifying smallgeographic areas where the populations of children and adolecents are at higher risk ofdeveloping oral disease.

Use of dental treatment in a French young children group

E BERT*, M FOLLIGUET, P BENETIERE

UFR Odontologie Paris 5, Caisse Primaire d'Assurance Maladie, France.

This work was conducted starting with given facts in the literature on the dental status ofchildren from 1-5 years, and the numerical record of the use of dental care on the temporaryteeth of 9.652 children benefitting from medical insurance in a French department. Material9,652 children born between 21/09/94 and 01/06/98, aged 1-5 years at the beginning of thetreatment taking place between 15/01/99 and 24/07/2000. Method The children were identifiedby their first names and dates of birth. No clinical examinations were conducted and onlystatistics were used. Orthodontic and prosthetic cases were excluded. Results: The outcomewas that out of 9.652 children there were 26.525 treatments : 8,948 consultations (34%), 1,286extractions (5%), 10,998 restorative treatments (41%), 1,604 hygiene treatments (6%) and3,689 X-rays (14%). This treatment was received by 43% of children aged from 1-3 years andby 57% of children from 4-5 years. Altogether 45% of the treatments were conducted on 4-yearolds, who made up 42% of the group. Conclusion This study shows the necessity to extendpreventive measures for children from 3-5 years, to conduct the first oral-dentalexamination at 3 years and to use preventive program for identifying the children at riskas early as possible.

Developing the activities of the public oral health serviceemploying the European Quality Award (EFQM) Model

P LUUKKONEN(1), M-L FORSELL(2), P UTRIAINEN(3)

1 Director of the Western District2 Chief dental nurse3 Chief dental officer, Centre for Health and Social Services of the City of Jyväskylä, Finland.

The dental department of Jyväskylä health centre was evaluated from the appraisal aspects ofthe Balanced Scorecard (BSC) i.e. from the viewpoints of the taxpayer, the patient, thefunctional processes and the staff's ability to develop. The European Quality Award (EFQM) wasused as the practical tool of development from 1998 onwards. In developing measures for allaspects a remarkable change has been achieved during the 1990s; the output/input ratio as wellas the effectiveness of activity is nowadays measured for every employee separately.Development work has resulted in a model of operation which enables the whole population touse municipal dental services according to the following priorities:

Children and young people (0-17 years of age), comprehensive care on a full coverage basis toassure the optimum health of the masticatory apparatus in adult age. The service covers allbasic and specialised care including orthodontic treatment.

Young people and adults (above 17 years of age) with the treatment content and priorities set inthe order below:

1. All people seeking dental care for an acute treatment need; access to treatment on thesame day including a scheduled plan for follow-up treatment

2. People having indications for dental care derived from medical conditions3. Clients having no need for emergency care or other health complaints described above

will first come to visit the oral hygienist whose task is to give individual instruction in homecare

In 2002 the cost for treatment to the taxpayer will be an average of € 35 per inhabitant of thecity. Care for patients under the age of 18 is free of charge and for those aged 18 and overdental treatment is cheaper than that offered by the private sector. About 28% of the city'spopulation utilised municipal dental services in 2001. For those examined, 9 children out of 10below the age of 6, and 6 children out of 10 aged 6-18, had no cavities requiring fillings. Thehighest need of treatment using the CPI Index was 2 or greater for slightly less than one third ofthe adult population. The European Quality Award Excellence (EFQM) Model and the BalancedScorecard (BSC) in combination proved to be practicable tools in the development of dentalservice activities.

Evaluation of an oral health education program addressedto 10-11 year-old children

M KOUSTELLI*, E MAMAI-HOMATA, H KOLETSI-KOUNARI, THATHANASSOULI

Department of Preventive and Community Dentistry, Dental School, National and KapodestrianUniversity of Athens, Greece.

University of Athens, Greece.

The aim of this study was to evaluate an oral health education program, which was implementedin 15 primary schools (approximately to 450 children, aged 10-11 years old) in Chalandrimunicipality, Athens. The program was carried out by volunteer dentists who provided a 45minute information in each class. A questionnaire was completed in class by the children, fifteendays before and four months after the implementation of the programme. The questionnaireincluded twenty questions, which were grouped in knowledge and behavior categories and werestatistically analysed. The statistical analysis of the data using the two-sample Wilcoxon, Mann,Whitney non-parametrical test, revealed that both children's oral health knowledge and behaviorshowed an overall significant positive change (P<0.0001 and P<0.05 respectively) between thetwo periods, but oral health knowledge presented better improvement. More specifically, thelevel of knowledge was improved most in aspects concerning fluorides, dental plaque andinterdental cleaning. As far as the oral health behavior is concerned, best improvement wasobserved in flossing frequency and in the use of fluoride mouthwashes. In conclusion, althoughthe dental health education program was implemented only once, it was found to be effective insome aspects.

The translation and standardisation of M-DAS into theGreek language

S ARAVOU*

Panteion University of Political and Social Sciences, Athens, Greece.

The purpose of this first stage research was to give the adequate translation and standardisationinto the Greek language of M-DAS (Modified Dental Anxiety Scale). The assessment of dentalanxiety has provided the development of many scales, as DAS (Corah: J Dent Res 1969;43:596), DFS (Kleinknecht et al. JADA 1984;108:59-61). The five item English questionnaire M-DAS (Humphris et al. Community Dent Health 1995;12:143-150), for which there is furtherevidence on its reliability and validity (Humphris et al. Int Dent J 2000;50:367-370), has beenchosen to be translated in Greek. Two professors of English language made the forward andback translation of the M-DAS and then it was given in a sample of 45 persons. Thirty (30) ofthem were regular patients from a private practice in Athens and fifteen (15) were dental phobicsattending Dental Clinic of University Hospital, in Heraklion-Crete. Test-retest to these 45persons, with an interval of three weeks, showed that correlation between pro- and meta-test foreach item and for the whole questionnaire has statistical significance (P<0.001). Factor analysisgave one factor for the Greek language, as it was in English (dental anxiety). Then it was givento a sample of 110 patients attending diagnostic clinic of Dental School in University of Athens (Mean=9.95) and to another 35 phobics from the above reported hospital (Mean=20.5). Theinternal consistency coefficient (Cronbach a) demonstrated high levels of reliability (0.9). Datasupport the psychometric properties of M-DAS for the Greek language.

Greek dental students' attitudes toward tobacco controlprogrammes

A POLYCHONOPOULOU, T GATOU*, T ATHANASSOULI

University of Athens Dental School, Greece and Hiroshima University School of Dentistry,Japan.

Japan.

The study explores the preparedness of Greek dental university students for advising patients toquit smoking. In addition, it examines how the awareness of the students is modified from thebeginning of the university studies to the graduation and how it is associated with their smokinghabits. Officially registered dental students (n=165) participated in the study and providedinformation by completing anonymously a 16-item questionnaire. Data analysis was conductedwith the use of standard univariate statistical methods, whereas multivariate analysis was donewith the logistic regression modeling. Students showed significant knowledge attainment ontobacco health effects from the beginning of their studies to graduation, although 54% ofgraduating students were not aware of an association between smoking and implant failure.More that 80% of the students considered tobacco cessation counseling a duty of every dentist,although 32% of the students believed it to be ineffective. Almost half of the students feltunprepared to provide tobacco counseling, whereas 86% of them were willing to participate ineducational programmes specifically designed for this purpose. Students' attitudes towardtobacco cessation counseling did not differentiate from the beginning of their studies to theirgraduation, although they were modified by personal smoking habits, while never smokersbeing significantly more optimistic than smokers about the effectiveness of tobacco cessationactivities. Dental school students represent a promising baseline for education on tobaccocontrol protocol development and clinical tobacco cessation intervention techniques.This study was supported by the University of Athens Special Account for Research Grants.

Oral self-care behaviors: comparing Greek and Japanesedental students

POLYCHRONOPOULOU*, M KAWAMURA

A University of Athens Dental School, Greece, and Hiroshima University School of Dentistry,Japan.

The purpose of the investigation was to explore cross-cultural differences of self-reported oralhealth behavior between Greek and Japanese dental school students. Eight hundred seventyseven dental students were enrolled in the study, 539 students registered at the University ofAthens Dental School, and 338 registered at the Hiroshima University Dental School. Oralhealth behavior was assessed by using, respectively, the Greek and Japanese versions of a 20-item questionnaire entitled Hiroshima University - Dental Behavioral Inventory (Kawamura.Hiroshima Univ Dent Soc 1988; 20: 273-286). The mean questionnaire score of the Japanesestudents (7.40) was significantly greater than that of the Greek peers (6.86, P=0,001), however,the overall difference was mainly attributed to the 6th study year of the Japanese students.From the examination of independent questionnaire items through logistic regression modeling,it was discovered that there existed considerable differences in dental health attitudes/behavioramong students in the two counties. This finding reflected different culture and health educationsystem of the students. The results suggest that it is possible to distinguish Greek dentalstudents from Japanese peers with a probability of more than 89% by using the HU - DBIinstrument.

Model for calculating treatment time based on dentalneeds of children in a community programme inStockholm County

L KARNSTRÖM*

Dental Care Committee, Stockholm, Sweden.

Children up to 19 years of age get free dental care in Sweden. Dentists are paid by CountyCouncils for giving this care. There have been various views about the size of thereimbursement (fixed fee per child). Therefore, the Dental Care Committee of the StockholmCounty Council has presented a new calculating model, based on the needs of children indifferent districts of the County. Needs are transformed into treatment time required to giveappropriate care. Treatment time can, in turn, be expressed in monetary terms. A prerequisitefor calculation is good epidemiology that gives informa-tion about the number and age ofchildren and their dental health so that frequency distributions of caries lesions can be obtained.Dentists were asked to design different treatment plans depending on age and number of carieslesions, including examinations, fillings, prophylaxis, calculated risk for injuries and periodontaldisease (specialized dentistry and collective prophylaxis were not included here). Five suchtreatment groups were defined for children in each age group to be called to dental check-ups.Treatment time for each treatment group could be calculated using data obtained from dentistson how many minutes were needed for each dental care measure. When the mean treatmenttime of all children in different districts of the County was calculated for a two-year period, therewas a span from 33 to 100 minutes. The total average for the County was 70 minutes. Thelongest mean times were found in districts with the lowest socio-economic levels. The resultswill be used to determine a differentiated fee, based on the proportions of the various treatmentgroups requiring different treatment times. Dentists will thus get different fees depending onwhere the children live, instead of the fixed capitation fee that is used today.

Evaluation of an AIDS education program in a Greek highschool

D DIMITRIADIS*, R KOSTANDINIDIS, P E PETERSEN, H TSELEPI

Dept. of Sociology, Greek National School of Public Health and Dept. of Community Dentistry,University of Copenhagen, Denmark.

This report presents the findings of a baseline and follow-up survey, of high school students ofthe town of Livadia, Greece. By February through May 1997 the Dept. of Sociology of the GreekNational School of Public Health, implemented an AIDS education program in all town highschools. A group of voluntary students, with the supervision of teachers and two dentists,members of the scientific team, were in charge of the implementation of special events in theirrespective high school. Self-administered questionnaires were distributed to the students ofdemonstration schools at baseline and after one year of programme, in order to measure theattitudes and beliefs about AIDS. Certain indicator variables were included for the evaluation ofthe program. The number of participants at baseline was 244 students (mean age=16 years)and at follow-up 138 students (mean age=16.5 years). The great majority (70%) of studentsseems to know the general modes of transmission of HIV and 93% of the students stated thatthey wouldn't leave their friend in case he/she is HIV+. Boys seem to be more sexual active andalso more careful with their relationship than girls (P< 0.001). One year after the programme,students seem to have better knowledge about the wrong ways of infection with HIV and agreater awareness about the importance of choosing their relationship (P< 0.05). Both atbaseline and follow up, there is a need for information by specialists, with active involvement ofthe school community, the families and the local community. In conclusion, students seem tohave a good knowledge about AIDS but clarification of the exact ways of transmission ofHIV and the negative feelings concerning the social consequences of the infection, have

HIV and the negative feelings concerning the social consequences of the infection, haveto be analyzed in with long-term school-based interventions, where dentist can play amajor role.

Pain perception by parents of children with Downsyndrome

M HENNEQUIN(1), D FAULKS(1)*, PJ ALLISON(2)

1 Faculty of Dentistry, University of Auvergne, Clermont-Ferrand, France 2 Faculty of Dentistry, MacGill University, Montreal, Canada.

The objective of this study was to investigate parents' ability to perceive pain experienced bytheir offspring with Down syndrome (DS). It has been suggested that individuals with intellectualdisability may have a decreased responsiveness to pain and that it may therefore be difficult forparents or carers to identify pain-related suffering in their wards (Fanurik et al. Dev BehavPediatr 1999;20:228-234; Hennequin et al. Lancet 2000;356:1882-1887; Biersdorff KK, Am JMent Retard 1994; 98:619-631). Data were gathered from parents of persons with DS in across-sectional survey using the Oral Assessment - Down Syndrome questionnaire (Allison PJ,Hennequin M, Community Dent Health 2000;17:172-179). Of 350 questionnaires distributed,204 responses relating to a child with DS (58.3%) and 161 relating to a sibling were returned.26-33% of parents had difficulty discerning if their child with DS was in pain, according to age,and they had difficulty discerning where the child felt pain in 68% of the younger group (<8years) and 22% of the older group (>8 years). Parents had much greater difficulty discerningpain experience for their child with DS than for the sibling nearest in age. Overall reports of painexperience were the same, however, for both children with DS and their siblings. Thesefindings suggest that while parents' ability to detect pain felt by their child with DS isfrequently compromised, they report the same dental pain experience for the child withDS as for a sibling without DS. This research was supported by the Coopération France-Québec, Programme Sciences et Technologie en Santé-Recherche Médicale and theFédération des Associations pour l'Insertion des Personnes Porteuses d'une Trisomie 21.

Cariology Research

Root surface caries in Hellenic elderly population

B TSOUNIAS, E ROZANA*, A PIROYNAKI-ROZANA

Geriatric Dentistry Studies Center of Hellenic Association of Geriatric Dentistry, Greece.

Root surface caries (RSC) is a subject of increasing interest in the industrialised countries, asthe elderly population is growing and more teeth are retained into old age. The aim of this studywas to determine root surface caries in Hellenic old people and the differences in prevalencebetween institutionalized and non-institutionalized old individuals. Material and methods A totalnumber of 829 dentate old men and women, over 65 years were examined for RSC in 7 nursinghomes (184 persons) and in 12 Municipal Daily Open Care Centers for the Elderly (645persons). All teeth were sound or had restoration or prosthetic crowns. The root surfaces werescored as follows: recession with a decayed root surface, recession with a filled root surface orrecession with a sound root surface. The prevalence of RSC was evaluated using Root Caries

Index (RCI). Results Non-institutionalised old people had 8 remaining teeth, 7,5 teeth withrecession, 2 teeth with RSC and mean RCI was 28,71. Institutionalised old people had 4,5remaining teeth, 4 teeth with recession, 3 teeth with RSC and mean RCI=89,22. ConclusionsThe prevalence of RSC in Hellenic old individuals is higher than reported from otherindustrial countries and RSC most frequently affected the institutionalised people.

The results and experiences from ART in Latvia

A ZIRAPS(1), E HONKALA(2)*

1 Stomatology Institute, Medical Academy of Latvia, Riga, Latvia2 Faculty of Dentistry, Kuwait University, Kuwait.

ART is technique, which is based on excavation of carious cavities using hand instruments onlyand restoring them with glass-ionomer cement. The new glass-ionomer "ChemFlex™" has beenintroduced with improvements in mechanical strength and a better handling.

The aim of the clinical trial was to test a long-term performance of the new glass-ionomer inclass I and II cavities in the permanent dentition of Latvian school children using ART technique.41 children were enrolled in the study and their age varied from 8 to 14 years (mean 11 years).They were randomly allocated into the control and the test groups. Altogether 63 restorationswere placed. The test group comprised 40 restorations and the control group 23, respectively.FUJI IX™ glass ionomer was used as the control material. At the 3-year assessment only 62%(n=39) of fillings were assessed, 69% (n=27) for the test and 31% (n=12) for the control.According to criteria for ART restorations the results for the test material in class I revealed 59%(n=16) success and 15% (n=4) non success, where repair was needed. In class II 19% (n=5)were successful and 7% (n=2) non successful, where repair was needed. The control material inclass I showed 92% (n=11) success and 8% (n=1) non success, where repair was needed. Thetest and control sealants showed 25% (n=5) and 33% (n=4) complete retention, where 75%(n=15) and 66% (n=8) were lost.

It can be concluded that the sample size after 3 years has been dramatically reduced, butthe new glass-ionomer material for 3-year period has shown a satisfactory performancein terms of retention, marginal failure and fractures in all class I and class II cavities.

Caries prevalence among 9-year-old children in Germanyin the years 1994 to 2000

K PIEPER(1)*, A MOMENI(1)*, A SCHULTE(2)

1* Dept. of Pediatric and Community Dentistry, University of Marburg, Germany2 Dept. of Conservative Dentistry, University of Heidelberg, Germany.

Ten years ago, the federal legislature in Germany passed a law requiring the national healthinsurance system to pay for preventive measures which subsequently were introduced inschools and private practices. In 1993 public health insurance agreed to cover the preventivesealing of fissures.

To control the effectiveness of this system, examinations of representative samples of 9-year-old children were performed in twelve federal states in 1994, 1997 and 2000. DMF-T-valueswere assessed according to WHO-criteria. The samples were selected by a two-stage random

were assessed according to WHO-criteria. The samples were selected by a two-stage randomprocedure and consisted of 15419 (1994-95), 19464 (1997) and 18441 (2000) children. Allexaminations were performed in schools by calibrated dentists with the aid of dental mirrors,explorers and artificial light. DMF-T- and dmf-t-values were recorded according to WHO criteria.For the statistical analysis a special programme for dental surveys (GPRZ) was used.

Between 11.8% and 30.4% of the children in the various federal states had a sound dentition in1994/95, while in 2000 this figure was between 27.7% and 46.5%.

In the first examination (1994/95) mean D3+4MF-T values between 0.7 and 1.6 were found,while after the third evaluation D3+4MF-T values between 0.31 and 0.75 were observed. Thesedifferences were statistically significant (P<0.05, U-Test). Thus the caries reduction ranged from28% to 65.8% in a time span of 6 years. The mean D3+4MF-T values for Germany decreasedfrom 0.98 in 1994 to 0.59 in 1997 and 0.45 in 2000. It is concluded, that caries prevalencediffers in the various German federal states. Nevertheless, due to intensified preventivemeasures in all German federal states caries prevalence has been reduced considerably.

Acid resistance of enamel treated with aluminium andfluoride: A PLM study

H KOLETSI-KOUNARI*, H MAMAI-HOMATA

Department of Preventive and Community Dentistry, Dental School, National and KapodistrianUniversity of Athens, Greece.

Concerning the prevention of dental caries and especially for caries risk persons, much attentionhas been given to the search for optimal methods of remineralisation of incipient enamel caries.Among other agents, Al salts have been proposed, in many studies, as having cariostaticproperties. The purpose of this in vitro study was to investigate the ability of Al and F solutionsto remineralise presoftened bovine enamel and enhance its resistance to acid using PolarisedLight Microscopy. Forty presoftened bovine enamel slabs were subjected daily to twodemineralisation and two remineralisation cycles for six days. The slabs were immersed twicedaily for 1 minute in Al and F solutions. At the end of the cycles the slabs were exposed to a 5-day Acid Resistance Test without any further treatments. At the end of the ART all slabs werecut in thin sections of 100-140µ for polarised light examination. The photomicrographs revealeda resistant surface zone covering the subsurface lesion in all groups of slabs apart from thenegative control. The same findings were also previously found using surface microhardnessmeasurements. The results of the present study show that topical treatments with Al solutionsapplied alone or in combination with F can decrease enamel acid dissolution. The experimentalmodel used in this study simulates to a degree the real oral cavity conditions and the applicationtime of the solutions used is one minute, so it could be applied in vivo.

Diagnostic Systems

Economic evaluation of tolonium chloride for the earlydetection of oral cancer

A I ZAVRAS*, A VAMVAKIDIS, D ZAVRAS, N KATSIKERIS, NANDREOPOULOS

ANDREOPOULOS

Harvard Dental School, Boston, Ma. International Monetary Fund, Wash DC. USA. AthensGeneral Hospital, Greece.

Aim The primary aim of the study was to estimate the cost-benefit of a model screeningprogram for oral cancer (OC) in Greece. The program targets 100,000 high-risk individuals andutilizes tolonium chloride (Oratest, Zila Inc.) as a diagnostic adjunct to biopsies of subclinicallesions. Methods Heavy smokers and drinkers, persons with history of oral cancer and patientswith premalignant lesions composed the screening population. Data from a comprehensivecase-control study of 110 cases and 115 controls was used to calculate the expected incidenceof oral cancer in each group and the expected TNM staging of the disease. A separate hospitalrecord review was performed in 93 OC patients to identify the relative 5-year mortality rate,which ranged from 35% for Stage IV lip lesions to 95% for Stage I (floor of the mouth lesions).The range of treatment options and procedures per stage of disease was also recorded.Results Respective treatment costs (current market values) were stratified according to TNMstage. Significant cost increases were observed in stages III and IV, as compared with stages Iand II (P<0.05), mainly due to increased hospitalization and multi-modality treatment for laterstages. The cost-benefit model of the tolonium chloride selective screening program for high-risk individuals (sensitivity: 73.3% & specificity: 93.5%) demonstrated that such a public healthapproach would result in a significant benefit to the healthcare system of 1,421,000 euros(approx. US$ 1,258,000). The realisation of such a benefit is a result of early cancerdetection, which leads to lower treatment costs, increased survival and longerproductivity of the patient. Partially supported by NIDCR/NIH grant K23 DE00420-01.

The role of the general dentist in the diagnosis of childabuse

K VLASIADIS*, M KOUTSAMANI

Dental Clinic, University Hospital of Heraklion, Crete, Greece.

Nowadays child abuse is a serious social problem. It is a phenomenon that spreads fast,although evidence is difficult to reveal.

The term "child abuse" refers to the phenomenon according to which, one or more adults causeor allow others to cause either body damage or deprivation conditions to a child, in such a highdegree that often severe disorders of physiological, mental, affective as well as social type oreven death are brought about.

The aim of the current study is to present an overview of the latest epidemiological dataregarding child abuse in Greece and abroad, to indicate the most prominent diagnostic criteriathat will help dentists be more observant and finally to introduce general dentists to the legalknowledge they should share, in order to react in an effective way, when facing such episodes.As a servant of medical care provision, the dentist is responsible for a child' s protection andsafety.

We conclude that ignorance, or even more, the false belief that child abuse is a family matter,will not help relieve the child's torture.

Geriatric Oral Research

Programme of prevention for elderly institutionalisedpeople

A VEILLE-FINET*, M FOLLIGUET*, P CHARRU**

*UFR Odontologie, Paris V **Hôpital Louis Mourier, Colombes, AP-HP, France.

The protocol was set up for 111 institutionalised patients in a long-term care hospital. Theaverage age was 81,05 years and 75% were women. After having conducted an oralexamination, the authors set up a program of prevention particularly adapted to people ininstitution. A set of categories was used to determine various protocols of care depending uponthe state of the patient: patients with teeth, cooperative or not, edentulous patients, cooperativeor not, those wearing a denture, as well as those at risk of problems in swallowing. Thisprogramme also had a double focus: new patients entering the service for whom a protocol wasdrawn up to provide a well-documented dental assessment, and the care-givers who benefitedfrom a training in oral hygiene by referring dentists. After the establishment of protocols, anintermediate evaluation was conducted at 3 months to determine the impact of the project onthe patients' level of hygiene and the degree of participation of the care-providing team. Forthat, each resident became the object of a clinical examination with recording of the hygieneindex, compared with those observed routinely before the installation of the protocol.Comparison of hygiene levels before and after training showed significant differences inposterior teeth (P=0.02) and anterior teeth (P=0.0004). The practices of the care-providers wereenhanced starting with the medical and nursing records of the patients, which allowed anevaluation of the actual involvement of these personnel and the difficulties encountered inputting such a programme into operation.

The relationship of oral impacts and clinical status inelderly people in Athens, Greece

G TSAKOS*, W MARCENES, A SHEIHAM

Department of Epidemiology and Public Health, University College London Medical School, UK.

This study was designed to measure the prevalence of oral impacts and to investigate theirrelationship with clinical status in an elderly population in Athens, Greece. A cross-sectionalsurvey of independently living adults aged 65 years or older was carried out in two municipalitiesin Athens. The sample consisted of 681 people. Oral health-related quality of life was assessedthrough a modified version of the Oral Impacts on Daily Performance (OIDP) indicator. Analysiswas carried out separately for dentate and edentulous subjects and non-parametric tests (Mann-Whitney and Kruskal-Wallis) were used. 39.1% of dentate and 47.6% of edentulous participantsexperienced at least one oral impact affecting their daily life in the last 6 months. The mostprevalent impact was difficulty in eating. Among dentate subjects, the OIDP score wassignificantly related to the number of teeth (P=0.001), filled teeth (P=0.021), anterior spaces(P<0.000), natural occluding pairs (P<0.000) and natural posterior occluding pairs (P=0.003). Inthe edentulous sample, the OIDP score related significantly to denture adaptation (P<0.000),retention (P<0.000) and extention problems (P=0.004). It could be concluded that the level oforal impacts was considerably high in this population and that the number of teeth, the number

oral impacts was considerably high in this population and that the number of teeth, the numberof occluding pairs and the presence of anterior spaces in dentate and the quality characteristicsof the dentures in edentulous people seem to relate to the ability of a person to eat, speak andperform the majority of functional tasks related to the mouth.

Oral health problems and needs in nursing home residentsin Italy

R FERRO*, A BESOSTRI, B MENEGHETTI

Dentistry Unit, Ulss n15 Veneto Region, Regional Specialized Centre for Study, Prevention andTherapy of Dental Diseases, Italy.

A survey was carried out to evaluate the oral health problems and needs of elderly residents innursing homes. For this aim a special clinical chart with a questionnaire were arranged. Theparticipants in the study were selected by the directors of nursing homes on the basis ofcognitive status and willingness to be examined and interviewed. 116 collaborating people (91women and 25 men) aged 55 to 99 years were visited in 4 nursing homes in the area of Ulss n15 in the Veneto Region, Italy. Results of the dental screenings of these 116 people showed twomain groups :edentulous 42 (36.2%) and dentate-with some natural teeth -74 (63.8%). Amongstthe edentulous group 10 people (8.6% of the entire group) did not wear any kind of denture. Inthe dentate group 23 (31%) were edentulous in a jaw and 9 out of these did not wear denture.The greatest single need among dentate elderly was for routine oral hygiene (45%), while fordenture wearers adjustment of loose dentures was the primary need (32%). Root caries wereslightly more prevalent than periodontal problems (34% vs. 32% respectively) among dentateelderly. 75 out of 116 (64,6%) reported to be moderately satisfied of their oral situation. Anywaysome form of oral health maintenance was needed for 90% of these nursing home residents.These results suggest that daily oral hygiene and regular check-ups by a dentalprofessional are most needed by frail elderly. Education of nursing home staff and theelderly themselves in the importance and methods of home care are also critical needs.

Oral & Dental Hygiene

Non-carious dental lesions and oral hygiene

E YURCHUK*

Dept. of Restorative Dentistry, Belorussian State Medical University, Belorussia.

The objective of the investigation was to study the prevalence of tooth grinding and erosion inthe population of the Republic of Belorussia, as well as interrelation of these conditions withhygienic habits in the population. Altogether 1482 subjects (aged 17-65 years and over) wereexamined. During their examination the condition of dental hard tissues for diagnosing non-carious lesions along with oral hygiene by OHIS index (Green-Vermillon, 1964) were assessed.All subjects were questioned on various aspects of oral hygiene. Results: High prevalence oftooth grinding was revealed in all age groups. Tooth grinding and erosion prevalence tend toincrease with age. The percentage of grinding at the age of 17 is 16% while in the age group of35-44 it increases up to 40%. No tooth vestibular surface erosion was diagnosed in subjectsaged 17, while in the age group of 35-44 it was 5.4%. In the studied subjects of 17-24 years of

age with good and satisfactory hygiene by DIS (OHIS-index component), the prevalence ofwedge shaped deformation was 4.1 times higher than in subjects with poorer hygiene (DIS >1.7), P<0.01. In case of proper oral hygiene the risk of wedge shaped deformation appears tobe higher with tooth brushing more than twice a day. Among 15 respondents (aged 17-24) whostate they brush their teeth 3-4 times daily, tooth vestibular surface grinding was found in 4subjects (26.7%). It is 2.4 times higher than tooth grinding prevalence in the entire age group.Wedge shaped deformation was revealed in 1 subject (6,67%) out of 15 that is 10-fold higherthan 17-24 age group prevalence. High prevalence of non-carious lesions in Belorussianpopulation and their dependence on hygienic habits were confirmed.

Evaluation of different reinforcements to increase thefrequency of brushing behaviour in schoolchildren

N BORA*, G BERMEK SAYDAM

Faculty of Dentistry, Istanbul University, Turkey.

In communities where the establishment of oral care habits during primary socialisation does notsucceed, schools may implement preventive programs during the secondary sociali-sationperiod. This study aims to determine effective reinforcement material to sustain brushingbehaviour learned at school. Altogether 197 schoolchildren of 8- and 9-year-olds were firstverbally instructed for brushing action mixed of Fones, Scrub and Roll methods followed bydemonstration on models and in their mouth by leading their hands. When children learned toperform appropriate brushing and their knowledge increased; four test groups were designed: 1)reward for brushing performance in class, 2) disclosing solution after brushing, 3) repeatedinformation by class teacher and 4) motivation of parents groups versus the control group and 5weeks of experiment conducted at school. Pre- and post-PI and 5 times PHPI at weeklyintervals were estimated. Statistical analysis was carried out using SPSS 10.0. For PI (before-after), Wilcoxon Matched-Pairs Signed-Ranks, Kruskal-Wallis One-Way Anova and Bonferroniadjusted Mann-Whitney U tests were used. For the 5 subsequently measured PHPI, FriedmanOne Way Anova, Wilcoxon Matched-Paris Signed-Ranks, Kruskall Wallis One-Way Anova,Bonferroni adjusted Mann-Whitney-U test were done. Results showed that the reinforcementgroups performed better in routine brushing than the control group and regarding to intergroupperformance reward and staining were the best methods and the parent motivation was leasteffective (P < 0.001). It is concluded that reinforcements are needed to increase brushingfrequency in primary schoolchildren.

Periodontal Research:Diagnosis/Epidemiology

Radiological and morphological manifestations ofinflammatory diseases in periapical dental tissues

Y KABAK(1), S ANISHCHENKO(2)

1 Dept. of Restorative Dent2 Dept. of Morphology, Belorussian State Medical University, Belorussia.

The aim of the study was to compare the radiological features of chronic apical periodontitis andradicular cyst with pathomorphological changes in periapical tissues. Material was obtained from27 patients aged 20 to 80 years with chronic apical periodontitis and radicular cyst who hadundergone cystectomy and resection of the dental root apex during the remission of theinflammatory process. Biopsy material was fixed in 10 % formalin. Histological sections werestained with hematoxylin -eosin and the method of fluorescent antibodies was used for detectingviral antigens. In 5 cases the diagnosis of chronic apical periodontitits was confirmedmorphologically. The maximum focus of inflammation ranged from 3 to 7 mm in diameter. Onhistological examination biopsy material was presented as fibrous and maturing granulationtissue. Lumen signs and epithelial lining were not detected. Radicular cyst was diagnosedpathomorphologically in 22 cases. The maximum focus of inflammation ranged from 5 to 15 mm.When the size of the cyst exceeded 10 mm it enveloped the roots of 2 teeth. On histologicalexamination the cyst wall was presented as fibrous and granulation tissues with diapedetichematomas. Fragments of bone plates undergoing resorption were found outside the focus ofinflammation. Marked infiltration with segmentonuclear leukocytes was revealed in thegranulation tissue included into the periapical formation in 4 cases. It may be evidence ofthe persisting activity of an inflammatory process. The resolution of inflammation is probablyhindered by the presence in epithelial cells of Type I Herpes Simplex virus or Adenovirus whichwere revealed by immunofluorescence technique.

Tobacco and oral health

A BORUTTA*(1), A YURCHUK(2), S KNEIST(1), R SCHUSTER(1), OSVIRYDZENKA(2), K GERHARDT(1)

1 Dept. of Prev. Dent., Friedrich-Schiller-Univ. of Jena, Germany2 Dept. of Restorative Dent., Minsk State Medical Institute, Belorussia.

A clear association has been demonstrated between smoking and oral health condition. InBelorussia the prevalence of smokers is very high, even among young people. Therefore, apartial aim of a joint German-Belorussian project was to examine the influence of smokingbehaviour on oral health among dental students. 1000 undergraduate students of Minsk MedicalInstitute were randomly selected to participate in a sociological and clinical-epidemiologicalsurvey. Participants were interviewed about their tobacco use. The oral examination based onthe determination of the periodontal (CPI) and caries status (DMFT). Smoking frequency wasdivided into three categories: daily, sometimes, never. The Statistical Package for the SocialScience Version 10.0 (SPSS) at a 95% confidence interval was used for statistical analysis. Theresults are based on the data of 839 subjects with a mean age of 18.7 years. According tothem, 17.7% of the students smoked daily, 20.1% sometimes and 62.2% were non-smokers.The periodontal status showed for the majority reversible stages of periodontal diseases(CPI=1.8) with significant differences between daily smokers (CPI=1.92) and non-smokers(CPI=1,75). The caries experience was 3.5 DMFT (DT=0.4; FT=2.9; MT=0.1). Among smokingmales the caries prevalence was higher (3.1 DMFT) than among non smoking males (2.4DMFT). In conclusion the results reflected a moderate oral health condition withsignificant correlation between the smoking frequency and the prevalence of caries andperiodontal disease.

Particularly supported by Deutsche Forschungsgemeinschaft (436 WER 17/6/01).

Bacteriological findings in diabetic patients (IDDM) withintensified insulin substitution undergoing the longitudinal

intensified insulin substitution undergoing the longitudinaloral health intervention programme

J DUSKOVA, Z BROUKAL(1), A JIRKOVSKA(2)

1 Institute of Dental Research2 Institute of Clinical and Experimental Medicine, Prague, Czech Rep.

A group of 25 diabetics (IDDM) with the average age of 31 years and disease duration of 17years on an intensified insulin substitution (insulin pump or repeated daily insulin dosages) wasfollowed in the clinical trial lasting on the averge 6 years. Patients were comprehensively orallyexamined, treated if necessary, regularly recalled and in every ocassion instructed in the oralhealth performance. Following variables were recorded: DM duration time, treatment regime,glycaemia, HBA1, diabetes complications, DMFT, OHI-DI, CI, GI, PI, clinical attachment loss(CAL), oral microbiology. Results showed that the regular and comprehensive motivation ofpatients in the oral health performance with the regular maintenance periodontal care canimprove oral hygiene and gingival health (DI baseline vs. final 0.40-0.16, GI baseline vs. final0.23-0.17) however not to retard or stop the periodontal breakdown especially in molar regions(mean CAL baseline vs. final 1.01-2.45, molar region CAL baseline vs. final 1.39-3.82). Thisclinical experience was confirmed by the results of repeated bacteriological examinations. Inclinically healthy localities the bacteriological pattern showed sequential reduction of„periodontal" organisms (Fusobacterium, Veilonella, P. gingivalis. P. intermedia, A. a.) while inperiodontal pocket-associated localities the risk pattern lasted throughout the clinical trialirrespective of the improvement of oral hygiene and gingival health. Clinical and bacteriologicalparameters of periodontal status by the end of study, when compared with the baseline data,were distinctly better in IDDM patients who adhered to the time schedule of study and regularlypassed through recalls, treatment, examinations and oral health performance interventions.Supported by the grant of the Czech Min. of Health no. 000237790.

Periodontal treatment needs in a group of mildly mentallyimpaired Greek schoolchildren

W PAPAIOANNOU*, S GIZANI, A TSAMI, Z MANTZAVINOS, LPAPAGIANNOULIS

Dept. Periodontology and Dept. Paediatric Dentistry, University of Athens, Greece.

The study aimed to assess the periodontal treatment needs and examine the impact of the oralhealth behavior on the periodontal condition in a group of mildly mentally impaired Greekschoolchildren. Little data exist on the factors influencing the periodontal condition of this group,in general, and specifically for Greece. Such data would allow the organisation of a preventiveprogramme that would address not only caries but also periodontal health. The study sampleconsisted of 171 children (114 boys, 57 girls) with a mean age of 11.46 (SD: 1.92) years. Oralhygiene and gingival inflammation were recorded (PlI-Silness & Löe, 1964 and PapillaryBleeding Index-Muhlemann, 1977, respectively). The periodontal treatment need wasdetermined using the CPITN index (Ainamo et al., 1982). Multiple linear regression analysisexamined the effect of the factors on the periodontal condition. The results showed that the PlIwas 1.00 (SD: 0.67). Only 45.47% of the tooth surfaces examined was found to be free ofplaque. The value for the gingival inflammation was 0.47 (SD: 0.39). Scaling and root-planingwere necessary (CPITN 3 and 4) for 41.5% of the schoolchildren, while 57.9% needed oralhygiene instructions and/or supra-gingival scaling (CPITN 1 and 2). Only one child (0.6%) did

hygiene instructions and/or supra-gingival scaling (CPITN 1 and 2). Only one child (0.6%) didnot need any treatment (CPITN 0). The regression analysis showed that the frequency ofbrushing (negative effect) and the age of the first dental visit (positive effect) influencedsignificantly the plaque index. A strong positive effect of plaque was found for gingivalinflammation (P<0.01) and periodontal treatment need (P=0.02). The findings show thatperiodontal treatment needs are extremely high for mildly mentally impaired Greekschoolchildren. Oral health education should start at an early age and include emphasison gingival health. Supported by Unilever-Aim.

Epidemiology

Meta-analysis of reported performance in oralcancer/precancer screening

D R MOLES(1), M C DOWNER(1,2)*, P M SPEIGHT(1)

1 Eastman Dental Institute, Univ. College London2 University Dental Hospital, Manchester, UK.

Objective To conduct a meta-analysis of values reported in published reports for sensitivity andspecificity in screening for oral cancer and precancer. Method A literature search, whichincluded three databases, was conducted. Strict inclusion criteria were applied. Values forsensitivity (Sn) and specificity (Sp), from seven investigations, were expressed as a ReceiverOperator Characteristic (ROC) curve. Meta-analysis of the combined results was used toproduce a Summary Receiver Operator Characteristic (SROC) curve. Results The pooledweighted value of Sn from the seven studies was 0.796. From the SROC, the correspondingvalue of Sp at this level of Sn was 0.977 (95% CI 0.941, 0.991). When Sp was held at 0.977, the95% CI for the corresponding value of Sn (0.796) was 0.594, 0.912. Conclusions The reportsselected for eventual inclusion revealed a high level of heterogeneity with respect to thelocation of investigations, prevalence of lesions, the personnel used and other factors.Nevertheless, the meta-analysis indicated a generally high discriminatory ability inscreening for oral cancer and precancer in the reported studies.

Oral health status of adults in Denmark

U KRUSTRUP*, PE PETERSEN

University of Copenhagen, Faculty of Health Sciences, Dept. for Community Dentistry andCopenhagen Gerontological Oral Health Research Centre, Denmark.

Clinical-epidemiological data on oral health of the adult Danish population are limited. Theobjective of the present study was to provide for the analysis of the oral health profile of theadult population in Denmark and to assess the need for adjustment of the adult oral health careservices. Stratified cluster sampling was used for selection of participants nationwide. A total of1,115 individuals in the age groups 35-44 and 65-74 years were clinically examined. Theresponse rate was 61%. Clinical examinations of dental status, dental caries and periodontalconditions were carried out by use of WHO criteria (1997). Frequency distributions and meanswere computed for data analysis. The 35-44 year-olds had a mean of 28.1 teeth present, 98.8%had 20+ teeth and no edentulous persons were found; the 65-74 year-olds had a mean of 16.4

teeth, 54.7% had 20+ teeth and 17.9% were edentulous. Among the 35-44 year-olds 1.4% weredenture wearers against 57.4% of the 65-74 year-olds. The mean DMFT of the 35-44 year-oldswas 16.7 (DT=0.5, MT=3.9,FT=12.3) and the 65-74 year- olds had a DMFT of 24.8 (DT=0.8,MT=12.0, FT=12.0). The D-component was higher for men (P<0.05) while the M-componentwas higher for women (P<0.05). Regarding periodontal conditions, 29.4% of 35-44 year-oldshad shallow pockets and 6.3% had deep pockets whereas in the older age group 45.5% hadshallow pockets and 20.0% had deep pockets. For irregular dental attenders the DT component(D=1.2) was more than twice the figure of regular dental attenders (D=0.5), however, the totalDMFT for the two groups was similar. The level of oral health and treatment need of adultsindicate that reorientation of the oral health care system is required for curative as wellas preventive services. The study was supported by The Danish National Health Insurance.

Caries prevalence in Filipino children without access toconventional dental care

R HEINRICH-WELTZIEN*, B MONSE-SCHNEIDER, B BORUTTTA

Department of Preventive Dentistry, Erfurt, Commitee of German Doctors, Frankfurt, Germany.

The aim of this study was to determine the caries prevalence in 7 (n=349) and 10-year-old(n=359) Filipino children without any access to dental care in deprived rural communities inNorthern Mindanao. Caries was recorded using WHO diagnostic criteria (1997) by twocalibrated dentists. The percentage of children caries-free at age 7 and 10 was 7.5% and16.9%, respectively. In 7-year-olds the caries level was 0.7 DMFT ((1.1) and 7.3 dmft ((4.9),which was concentrated in the D/d components. In 10-year-olds the DMFT was 1.9((2.8) and2.4((2.7) dmft, exclusively concentrated in the D/d components. While the caries pattern in theyounger children revealed that the caries burden was localised to the first molars (0.6 DMFT),more than one third of the caries attack in the 10-year-olds was in the upper and lower incisorsand premolars. The caries prevalence and the pattern of the caries distribution suggests that theFilipino children are a high caries population. The high caries attack in the deciduous dentitionwas associated with severe carious in the permanent dentition. Because of the limited financialand personal resources, restorative treatment using ART was limited to permanent teeth.However, extraction of the carious deciduous teeth was the treatment of first choice. Invasivemeasures are prerequisites to control existing caries and pain. Only after doing that can primarypreventive measures be effectively used. In conclusion, there is a important need to developevidence based guidelines for basic oral care in deprived communities. Supported byVivadent, Schaan, Liechtenstein.

Fissure sealing - overtreatment or preventive need?

J KÜHNISCH*, H SENKEL, R HEINRICH-WELTZIEN, W TIETZE, L STÖSSER

Department of Preventive Dentistry, Erfurt, Health Department Ennepe-Ruhr-District, Schwelm,Germany.

The aim of this longitudinal study was to assess detailed the status of pits and fissures inpermanent molars to get information regarding their need of preventive care. 369 Westphalianchildren born in 1989 were examined as 8-year-olds (1997) and as 10-year-olds (1999). Thesurface-related caries status according the WHO criteria (1997) was completed by scoring non-cavitated carious lesions. Additionally, sealants in fissures and pits were recorded. A caries freemixed dentition was found in 36% of the 8-year-olds and in 39% of the 10-year-olds,

mixed dentition was found in 36% of the 8-year-olds and in 39% of the 10-year-olds,respectively. The caries experience was 2.4 dft/ 5.2 dfs/ 0.4 DMFT/ 0.5 DMFS at the age ofeight and 1.5 dft/ 2.9 dfs/ 0.6 DMFT/ 0.9 DMFS at the age of ten. 0.3 DS were registered on theocclusal surface of first molars in 8-year-olds and 0.4 DS in 10-year-olds. 1.0 fissure sealantswere scored in 8-year-olds and 1.4 in 10-year-olds. Sealed pits were rarely scored: 0.1 in 8-year-olds and 0.2 in 10-year-olds. The number of non-cavitated occlusal fissures raised from0.8 in 8-year-olds to 1.4 in 10-year-olds. 0.7 initial carious pits were registered in 8-yr-olds and1.0 lesions were found in 10-year-olds, respectively. According to the increasing numbers ofnon-cavitated lesions sealant application should be used more frequently by Germandental practitioners to prevent the carious onset in pits and fissures.

Caries experience among pre-school children in Westfalia

H SENKEL*, R HEINRICH-WELTZIEN, L STOESSER

Health Dept. EN-District, Schwelm, Department of Preventive Dentistry, Friedrich-Schiller-University of Jena, Germany.

Oral health improvements in pre-school children have been reported (Marthaler TM. Caries Res1990; 24:381-396) followed by first indication that the decline in caries levels in pre-schoolchidren came to a halt (Pitts NB, Palmer JD. Community Dent Health 1995; 12:52-58). The aimof this study was to evaluate the prevalence of dental caries in the deciduous dentition in 3-and5-year-old children attending kindergarten schools in the EN-district, Westfalia in 2001. Resultswere compared with previous surveys of 1987 and 1997. Simulating the clinical proceduresused in the national survey in Ireland (Stationary Office, Dublin, 1986) caries was diagnosed.The dmft was calculated (SAS database) and comparisons were made (Tukeys student rangetest; P value: 5%). In 2001 for 3-year-olds (n=255) a mean dmft of 0.53 (SD 1.80) was scored.In 1997 (n=165) and 1987 (n=287) mean dmft was 0.7 (SD 2.1) and 1.7 (SD 2.9), respectively.A caries decline occurred from baseline 1987 to1997 significantly (P < 0.0001) but did notcontinue to 2001 (P=0.039). Percentage of caries free children increased from baseline 57.1%(1987) to 81% (1997) to 89% (2001).The present mean dmft in 5-year-olds (n=531) was 1.46(SD 2.78). Between 1987 (n=683) and 1997 (n=531) the mean dmft of 3.0 (SD 3.5) decreasedsignificantly to 1.8 dmft (SD 3.4). No further decrease was observed to 2001 (P < 0.0747). Thepercentage of caries free 5-year-olds increased from 38.9% (1987) to 64% (1997) andremained the same with 66% (2001). While the period between the last two studies wasshort, the results could be the first indication that caries decline in these 3-and 5-year oldchildren has ceased.

Prevalence and distribution of cavited and noncavitedcaries lesions at 11 years old children

I OKTAY*, G BERMEK SAYDAM, F DOGAN

Faculty of Dentistry, Istanbul Universty, Turkey.

The aim of the study was to determine the prevalence and the distribution of cavitated andnoncavitated carious lesions to exhibit that when caries diagnosed solely at the cavitation levelthis will result in a significant underestimaiton of actual caries which might be especiallyimportant in epidemiological surveys. 510 children were examined by 3 calibrated dentists underblue-white colour light by plane mouth mirror and probe after children brushed and teeth weredried with cotton rolls. Lesions were diagnosed and distinguished by visual and tactile criteria.

dried with cotton rolls. Lesions were diagnosed and distinguished by visual and tactile criteria.Ten degrees were developed on the basis of information from the literature to diagnose as; 0:Sound; 1: Potentially carious (colored light or white change in side pits and fissures); 2: Inactive(intact surface); 3: Active (intact surface); 4: Inactive cavited (up to 0.5 mm diameter); 5: Activecavitated (up to 0.5 mm diameter); 6: Inactive cavitated (larger than 0.5 mm diameter); 7: Activecavitated (larger than 0.5 diameter); 8: Filled (sound surface); 9: Filled with inactive caries; 10:Filled with active caries. The distribution of potentially carious lesions, noncavitated lesions andthe cavitated ones were respectively 4.22%, 3.34%, 92.43% in deciduos teeth and 38.41%,6.44%, 55.15% in permanent dentition. While cavitated lesions were significantly higher indeciduous teeth than in permanent ones, the higher percentage of cavitated lesions were activecaries in both dentition with figure of 93%. It is concluded that diagnosis of caries should beprecisely made in regard to noncavitated lesions which might allow to design preventiveprogrammes with remineralisation methods especially suitable for teenage groups.

Treatment level and caries incidence in schoolchildren

G DIETRICH*, G HETZER

Department of Paedodontics, University of Technology, Dresden, Germany.

This retrospective study was designed to evaluate the results of dental screenings from 1996 to1999. All examinations were carried out by one experience dentist of the Public Health Care.Caries data (dmft, DMFT) of 6 to 9 year old children (n=272), attending 6 primary schools in theurban region near Dresden, were recorded annually. All children got regular preventive dentalcare in their groups. Statistical evaluation was performed using t-test (P<0.05). 107 (39.4%) of272 children were without caries (dmft / DMFT=0) (group 1), 67 children (24.6%) had treatedteeth (group 2) and 98 children (36.0%) had teeth with carious lesions (group 3). At baseline thedmft was 1.91 (2.18 (d=0.72 ( 1.33), the DMFT was 0.17 (0.58 (D=0.03 ( 0.19). After 3 years thecaries incidence was 1.21 (1.65 dmft / DMFT; DMFT 0.49 (1.02. There were notable differencesin the caries incidence between children with and without complete treatment. Caries increase ingroup 1 was lower (0.95) than in groups 2 (1.34) and 3 (1.41) (P<0.05). After 2 and 3 yearscaries more increased in group 3 than in group 2 (P<0.05). At the end of the study 87 children(32.0%) still had healthy teeth, 134 children (49.3%) had treated teeth, but 51 children (18.7%)children had carious lesions. Only 10% of children of group 1, but 19% of group 2 and 29% ofgroup 3 needed dental treatment. We conclude that regular and complete dental treatmentin addition to preventive measures is a considerable factor to prevent or to reduce cariesincidence in young schoolchildren.

Caries prevalence of 11 year-olds between 1989 and 2001

A DEMERTZI, V TOPITSOGLOU*

Public Health Center, Chrysoupoli, Kavala, Department of Preventive Dentistry, Periodontologyand Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.

The aim of the study was to examine retrospectively the effects of the Primary Health Caresystem on the caries experience of 11-year-olds, during a period of 13 years. The sampleconsisted of all the 2,217 children attending a Public Health Centre (PHC) in a province ofNorth-Eastern Greece. The prevention related factors associated with caries reduction, beyondearly treatment with fillings, consisted of annual oral health education and the topical applicationof fluoride to children at high-caries risk, while sealants were first introduced in 1995. The same

of fluoride to children at high-caries risk, while sealants were first introduced in 1995. The samedentist in the PHC carried out the examinations, during the regular routine visits of the schoolchildren. To analyse the dependent variable DMFT, the Poisson and the Binomial model wereused (assumption of normality failed). In these models, the 3 factors tested, Time (13examination years), Location of living (semi urban, rural highland and lowland) and Sealantsapplied (#0-16 per child, up to 94% of them) were highly statistically significant (P<0.001). In thelast 5 years the factor Location seems to affect only those with presence of caries (DMFT=1)and not the caries-free ones. Dental health was found to be good (DMFT=0) in increasingpercentages year by year (range 12-50%). The DMFT index decreased constantly from4.5(sd=3.16) (1989) to 1.81(sd=2.12) (2001). The SiC index for the 33% of children with thehighest DMFT scores decreased dramatically (from 8.08 to 4.23). In conclusion, the dentalcaries status of the 11-year-olds had vastly improved over the13 years largely due to theexpanding use of sealants.

The effectiveness of a longitudinal oral health educationprogramme in Flanders, Belgium

J VANOBBERGEN*, L MARTENS, D DECLERCK

Dept. Pediatric Dentistry, PAECOMED, Gent University; Catholic University Leuven, Belgium.

The aim of this study was to evaluate the effect of a 6-year oral health promotion program forprimary schoolchildren. This programme was part of the Signal-Tandmobiel® project, alongitudinal collaborative project combining the registration of oral health condition data and oralhealth promotion. The intervention group comprised 3,291 children with a mean age of 7.1 yearsat the start of the programme. These children received an oral health education programme,which consisted of a yearly one-hour lesson. Every year the children were examined clinicallyand a questionnaire, filled in by the parents, was administered to assess the oral healthbehavior. Data collected from a control group of 674 12-year-old children were included asreference. The representative samples were obtained using a technique of stratified clustersampling. The mean DMFT/S values, although higher in the control group, were not significantlydifferent in the participating children and the controls. The frequency of brushing was the samein both the intervention and the control group. Significant difference in favour of the interventiongroup was found in the number of between meal snacks and the proper use of topical fluorides(P < 0.001). Children in the control group showed significantly lower proportion of filled teeththan those in the intervention group (P < 0.05), with a care index of 73% versus 80%. Inconclusion, the implemented yearly school-based oral health education program did not result insignificant reduction of the caries prevalence measured. The program has been effective inimproving the oral health behaviour and in stimulating dental attendance, resulting in a highercare index.

Prevalence of developmental defects in enamel in a youngpopulation of Paços de Ferreira, Portugal

J FRIAS-BULHOSA*, P ROMPANTE, F BAPTISTA

Department of Child's Oral Health and Prevention, High Institute of Health Sciences- North,Paredes, Portugal.

The aim of this study was to determine the prevalence of developmental defects in dentalenamel in a young population of Paços de Ferreira district in the North of Portugal and thepossible relation with the medical history. The data were collected using the examination criteriaof the modified DDE index, and a questionnaire was used for the subjects or for the parents fordetermination of medical history and habits. The sample (n=132) with an age between 12 and17 years (mean 15.2); 54.5% being girls. Results: The prevalence of defects was 36.4% and themost prevalent teeth effected were the incisors, 33.3% of the sample had demarcated opacities,29.2% had diffuse opacities and 20.8% had enamel hypoplasia. The odds ratio were significantfor the history of received medication for the colic or the otolaryngological problems: 3.60(1.70;7.61) or for the fluoride supplement intake 2.50 (1.03;6.05), but not for the trauma or forthe other conditions.

The monitoring of enamel defects has an important role in public health by the prevention ofundesirable changes in tooth appearance. Defects of tooth enamel are still prevalent betweenyoung people especially those with history of infection in infancy.

Does a regular pattern of dental attendance preventchildren from a low socio-economic background havingdental pain?

P S A GOES*(1, 2), R G WATT(2), A SHEIHAM(2)

1 FOP-UPE, Brazil2 UCL, UK.

There was a significant reduction in dental caries in Brazilian schoolchildren in the last decade.However, this reduction was not the same for all groups and little is know about the impact ofdental problems on the daily life activities in the young population. The aim of this study was toreport the prevalence and characteristics of dental pain in schoolchildren related to socio-demographic variables. A cross-sectional survey involving 1,052 out of 1,200 (87.6%) 15-year-old adolescents enrolled in private and public schools in the urban area of Recife-PE Brazil wascarried out. The prevalence of dental pain was recorded using standard measuresrecommended for this age group (Melzack, 1992; Sherphed, 1995; McGrath; 1996).The childrenwere examined, interviewed and answered a self-complete questionnaire. Data analysisincluded bivariate analysis followed by multiple logistic and ordinal polytomous regression Theoverall prevalence of toothache in the last six months was 33%. It was found a statisticallysignificant interaction between pattern of dental attendance and socio-economic position (P<0.1). Schoolchildren from low socio-economic background who attend the dentist regularlyreported more dental pain (OR=1.9 95% CI=1.3, 2.9, P<0.001) more dental pain than theircounterparts from high socio-economic background after adjusting for other variables. Theprevalence of dental pain in Recife was high. The results indicated that conventional dentalservices and strategies are not coping adequately with urgent dental needs. In conclusion, thehigh rates of dental pain in children who attend the dentist regularly is a strong indicationof the need for oral health promotion. This project was supported by CAPES.

Caries Prevention

Reported toothbrushing and mean DMFT in adolescentchildren in Europe

children in Europe

C M JONES*

Highland Health Board, Inverness, Scotland, UK.

Objective To assess any relationship between reported tooth-brushing in adolescents andDMFT of 12-year-old children across Europe. Background Toothbrushing with fluoridetoothpaste is a strong risk factor negatively associated with dental health when viewed on anindividual or group basis. This study assessed that association across the continent of Europe ata National level. Methods Mean DMFT of 12-year-olds from the WHO database and reportedtoothbrushing by adolescents in the Health Behaviours in School Children survey, werecollected for European countries. Spearman's correlation coefficients were calculated using thetwo variables. Results There was over a four-fold variation in mean DMFT. The reportedprevalence of brushing more than once a day varied from 63% to 88% in 15-year-old females.There was a strong, negative, statistically significant association between reported toothbrushingmore than once a day and DMFT (Spearman's rho=-0.88, P<0.01, N=10). Results for availableage/gender groups showed weaker correlation's with similar statistical significance.Conclusions The significant association between reported toothbrushing and DMFT isconsistent with previous research and is likely to be causal. Reported use of fluoride toothpastehas a consistent effect in reducing dental caries across Europe using national data. This studyconfirms that national reported toothbrushing habits are strongly associated with lowernational levels of tooth decay across European Countries.

Caries preventive interventions in Filipino children -Results after three years

B MONSE-SCHNEIDER*, R HEINRICH-WELTZIEN, A SHEIHAM

Commitee of German Doctors, Frankfurt, Dept. Preventive Dentistry, Erfurt, Germany; Dep.Epidemiology and Public Health, University College London, UK.

This study was designed to evaluate the effectiveness of a WHO-supervised school basedpreventive programme for Filipino children. 19 primary schools in deprived communities of ruralareas in Northern Mindanao had been selected to take part in the programme. By using WHOcriteria (1997) one dentist examined 1,574 children with an mean age of 7.1 years. Thepercentage of caries free children was 8.8%. Caries levels were 1.2 DMFT ((1.4) and 7.2 dmft((5.1). Fillings were not present in either dentition. The mt value was 0.2 (+ 0.7). The preventiveprogramme focused on preventive (dietary control, supervised toothbrushing with a fluoridatedtoothpaste, professional application of fluoride varnish). In order to cope with the high treatmentneed invasive measures (extractions of deciduous teeth, ART-fillings in permanent teeth) wereincluded. 1,162 children with a mean age of 10.2 years were re-examined after three years ofthe programme. The percentage of caries free children was 16.2. Caries levels were 1.6 DMFT((1.8); 0.5 DT, 0.2 MT and 0.9 FT. The increment of 0.4 DMFT and the distribution of the DMFTcomponents in high caries risk Filipino children reflects the effectiveness of a comprehensivedental care approach. Extractions of carious deciduous teeth and ART-restorations inpermanent teeth might have an important impact by reducing the microbial infection levels in theoral cavity. We conclude that invasive measures seem to be a prerequisite for the cariespreventive effect of daily toothbrushing with fluoridated toothpaste in children with highcaries experience, particularly in the mixed dentition. (Supported by Vivadent, Schaan,Liechtenstein).

Factors influencing infant feeding practices potentiallydetrimental to oral health

C MURDOCH, K F ROBSON, I G CHESTNUTT*

Dental Public Health Unit, University of Wales, College of Medicine, Cardiff, UK.

Background Sugar rich drinks are a recognised risk factor in early childhood caries. Currently,in depth knowledge of factors influencing mother's choice for feeding bottles and cups isincomplete. Objectives This study investigated parents and carers knowledge of feedingpractices potentially detrimental to oral health; barriers to adopting safe feeding practices; andcommercial factors influencing feeding bottle and cup contents. Methodology A qualitativeapproach using semi-structured interviews was employed. Interviews were conducted by anexperienced researcher and tape recorded. Following full transcription, emerging themes wereidentified, systematically explored and validated within the verbatim accounts. 33 parents/carersof children aged < 3 yrs, resident in areas of high caries prevalence were involved. ResultsOverall knowledge of the prolonged effect of exposure to sugar drinks in feeding bottles andcups was poor. Greater concern was expressed over the use of bottles on the development ofthe occlusion. Milk was viewed as a food rather than as a drink. Many barriers to giving waterwere described: children reject it; mothers don't like it; it was 'cruel' to offer water instead ofsweet drinks; water in feeding bottles or cups was seen as a sign of poverty. Commercialinfluences on choices were strong. Products offered by baby food manufacturers were viewedas safe, but a recently marketed "Toothsafe" drink was viewed with suspicion. ConclusionsThere are significant barriers to adopting the traditional oral health education messagethat only milk and water are truly safe for teeth. The support of Cardiff Sure Start isacknowledged gratefully.

Toothpastes for children in the Czech market network;fluorides, labelling and customers information

Z BROUKAL*, D HOUSOVA, J DUSKOVA, E LENCOVA

Institute of Dental Research, 1st Faculty of Medicine, Charles University, Prague, CzechRrepublic.

Early onset of oral hygiene practices in children belongs to the decisive items in primaryprevention of dental caries. The employment of appropriate fluoride toothpastes is of utmostimportance both for effective prevention and for safe topical fluoride application. Labelling oftoothpastes and customers information on covers are thus critical for their correct choice andusage. The survey of brands of toothpastes designated for children was conducted in the Czechmarket with the aim to determine to what extent their labelling and cover information adhered tothe EN ISO 11 609 and to the recommendations of the European Academy of PaediatricDentistry (EAPD) (Oulis J.C. et al., Eur.J.Paed.Dent., 2000; 1:7-12). Altogether 32 brands ofchild toothpastes were evaluated. Labelling and cover information of 30 of them adhered to theEN ISO 11 609 (fluoride component alleged), 2 brands were signed only to contain 'activefluoride'. With regard to the EAPD recommendations for child toothpastes labelling (appropriatechild age, marked fluoride content, pea size dose to toothbrush recommendation, not to swallowwarning) only 2 brands were found to carry optimal information. Picture design of covers mostlydid not correspond to the age of child for which the respective brand of toothpaste would beadvisable. The labelling and cover information of the assortment of child toothpastes in the

advisable. The labelling and cover information of the assortment of child toothpastes in theCzech market, even if largely adhering to the EN ISO 11 609, were found to bear insufficientinformation for customers for correct choice and apropriate usage.This study was supported bythe institutional grant of Ministry of Health Czech Rep. No. 0002377901.

National programme for caries prevention in Romanianschoolchildren

I DANILA*, M PARUS, C HANGANU, L BARLEAN

University "Gr. T. Popa" Iasi, Faculty of Dentistry, Dept. of Preventive and Community Dentistry,Romania.

This paper aims to point out the contribution of Preventive and Community Dentistry Discipline,Faculty of Dentistry - Iasi, Romania, in initiating a caries preventive program for children ingrades I - IV, in five cities (Iasi, Bucharest, Tg. Mures, Constanta, Timisoara). In 1992, incollaboration with WHO regional center we performed an epidemiological study concerning theoral health status in 345 children aged 12 and 342 children aged 6, using the Danish recordingform. Mean values for DMFS in 12 year olds were found to be 6.3 (SE=0.3) and for defs in 6year olds were 8.5 (SE=0.6). Data were managed using Statistical Analysis System (SAS) forcomputers. A total of 200 6 year old children were introduced in a comparative study concerningthe efficacy of local fluoridation using NaF 0.2% solution once a week. After six years resultsshowed statistically significant reductions in DMFS index in the test group comparing to controlgroup. The SPSS 8.0 for Windows statistical software was used for data management andstatistical tests. As a result, in 1999 the decision makers in public health approved and financedfor the entire children population in I - IV grades, in the five cities mentioned before, a cariesprevention program based on mouth rinsing with NaF 0.2% solution, once a week. After threeyears, a total of 12,204 children in I - IV grades from Iasi are continuing the prevention program,corresponding to a response rate of 97.9%. It can be concluded that in Iasi the CariesPreventive Programme is a success.

Other

Guidelines for the treatment of dental patient withdisabilities in the surgical section

C GALLO*, E BALDANTONI, C BOVO, C MONGIAT, T SALA, M MANCIN, RTARDIVO, G RUBIN, S SAMBIN

Community Dental Service, Chioggia, Regione Veneto, Venice, Italy.

The aim of the study is to define the guidelines for hospital based clinical management ofpatients with disabilities in the peculiar moment of the dental treatment under generalanaesthesia. The purpose was to reduce level of anxiety of the patient and health professionals.Methods: Family questionnaires were used for data collection. Our guidelines concern a clinicalpathway, and the patient is always with a member of the family or a devoted caretaker. The daybefore the treatment, the first contact between the patient, the family and the dental team takesplace. This is an extremely important step, when the patient meets the operators and startsmaking their faces and voices familiar, the parents are explained, how the transport from the

making their faces and voices familiar, the parents are explained, how the transport from thedental surgical ward to the surgical section will be arranged. The day of the treatment thepatient, the parent and a member of the dental surgical team go together to the pre-anaesthesiaarea:, where the pre-anaesthetic assessment starts and the venous access is created. Thepatient, slightly sedated, is moved to the surgical area and only at this point the parent retires.Conclusion: Following this protocol the disabled patient arrives at the moment of theanaesthesia with a diminished level of anxiety and the physical immobilization is notnecessary; operators' apprehension decreases too. This innovative care pathwayachieved an excellent compliance of the patients with disabilities.

Prevalence of candidosis among hospitalised patients inlong-term care facility

M FOLLIGUET*, Ph CHARRU, A VEILLE-FINET, I KIRZENBLAT

UFR Odontologie Paris 5, Hôpital Louis Mourier AP-HP, France.

The study was carried out on 110 patients, older than 65 years, hospitalised longer than 48hours, in a long-term care facility. The average age was 80.52 years and 73.63% were women.The aim of the study was to determine the prevalence of candidosis, defined by the associationof clinical warning signs and of a positive fungus diagnosis defined by the presence of yeasts ina direct examination and a positive culture from a specific location. A complementary study wasconducted on the statistical link between candidosis and known geriatric risk factors: wearing adenture, antibiotic treatment in the month preceeding the examination. Altogether 91 patientshad clinical oral examination; 17 refused the clinical examination; 3 refused the clinical andfungal examinations and 2 patients were absent. The prevalence of candidosis was 15.38%.The organisms recovered were Candida Albicans (57.1%), Candida Albicans in association withCandida Glabrata (21,4%), Candida Glabrata (14.3%), and in one case there was anassociation of Candida Albicans and Candida Tropicalis. 5 out of 19 patients wearing a denturehad candidosis (26.3%). 4 out of 13 who had received antibiotic treatment during the preceedingmonth presented candidosis (30.8). Of the 14 patients who refused the clinical examination: 5had a positive direct examination and a positive culture (35.7%) determining the prevalence ofcandidosis (17.6%). 5 patients (6.5%) had a negative clinical examination, but positive directand culture examinations. High prevalence of candidosis observed in this study would requirepreventive measures among hospitalised patients.

Inequalities in private dental expenditure in Greece:Comparison between 1987 and 1998

M MANDONANAKI*, H KOLETSI-KOUNARI, A DOLGERAS, JKYRIOPOULOS

Department of Preventive and Community Dentistry, Dental School, University of Athens.National School of Public Health, Athens, Greece.

In Greece more than 90% of dentists practice privately and this reflects the fact that more than1/3 of the total private health expenditure is given to oral health by family budgets. The purposeof this study was to compare private dental health consumption expenditure between the years1987 and 1998, and to present some evidence (a) on the overall change and trends and (b) onregional- and income-related differentiations. Primary data were derived from the Statistical

regional- and income-related differentiations. Primary data were derived from the StatisticalService of Greece and National Household Accounts. The analysis of the data revealed, amongothers, the following: 1. In 1998 private dental health consumption expenditure at constantprices, increased by 20.4% in comparison to 1987, while it presented a slight decrease aspercentage of the total private health consumption expenditure (36.7% in 1987 and 34% in1998). 2. In both years, the largest amount of the total dental health consumption expenditureper capita is observed in urban areas and in 1998 it presented a further increase by 27.2%,while in semi-urban and rural areas it was decreased (by 30.8% and 16.6% respectively). 3. Thetotal annual consumption expenditure per capita is distributed according to monthly income ofthe population, but in 1998 these differences were more pronounced and higher income groupspresented an increase of 73.5%, while low-income groups presented a decrease of 64.1%).

Oral health and dental problems in a group of deafstudents

V MOUTSOS*, O PHOTIADOU, G MOUTSIOS

General Hospital of Serres, Dental Department, Serres, Greece.

Purpose The aim of the present study was to determine the caries experience and thetherapeutic needs of a group of deaf students, to set baseline data and to determine theirtreatment need. Introduction Hearing defecits in childhood can result in lifelong impairments inreceptive and expressive language skills. About 1/1000 newborns have severe to profoundhearing loss at birth and another 3/1000 children acquire moderate to severe hearing lossduring childhood. People with a sensory impairment are entitled to equal standards of healthand care as their able bodied cohorts. Material and method The sample consisted of 21 deafadolescents aged 12-17 years. All were students in a special needs school in the region of thecity of "Serres" - Greece. A matched control group of 21 healthy students of the same age andfrom the same region attending public schools has been used in order to compare the findings.Results Similar dental caries experience existed in the two groups. The deaf populationobserved in this study exhibited a relatively higher amount of plaque. The mean DMF(T) valueof the deaf group reached the score of 3.91. Oral Hygiene Index - Simplified (OHI-S) wasconsidered high in both groups. Treatment needs index for the deaf children was estimatedwithin the range of 79 to 100%. Conclusions The findings indicate no great differences inthe oral status between the hearing impaired and the healthy students. A greaterpercentage of the deaf children require immediate dental treatment due to poor oralhygiene and gingival health. Preventive dental intervention programs should neverexclude these population groups with the excuse of serious communication problems.

Lavrion silver and lead mines and oral health status

P DAMASKINOS*, I LAMBADAKIS

Evangelismos General Hospital, Athens, Greece.

The purpose of this study is to evaluate the impact of lead mines in the oral health status of thepopulation of Lavrion (Attica). The principal lead ore of the area is mainly galena followed byPbS, and this is usually associated with the sulfides of silver, copper, arsenic, bismuth and tin.Other common ores of lead are cerussite, PbCO3 and anglesite, PbSO4. Lavrion has beenfamous for its silver and lead mines and had contributed to the economy of Ancient Athensmainly since the beginning of the 5th century BC. It is also well known that the people in Lavrion

mainly since the beginning of the 5th century BC. It is also well known that the people in Lavrionhave "colored teeth" due to fluorosis and the DMF index is lower than other places in Greecebecause of the fluoridated rocks and minerals of the area. Lead poisoning may occur in industryworkers and the inhabitants of the area. The toxic effects of lead were familiar to Greek andRomans. Hippocrates (370 BC) described a severe attack of colic in a man who extractedmetals, and was probably the first to recognise lead as the cause of the symptoms. Materialand method The results of 14 epidemiological studies (1940-2002) and historical data areanalysed and presented. Four studies took place during the years 1940-1965 and ten during theyears 1987-2002 - in school children, adults, and industrial workers. Results: Caries index issignificant lower in the area and fluorosis index (Dean 1942) is recorded. Fluorosis is present inabout 70% of the adult population; recent data show absence of fluorosis in children less than16 years old. Conclusion Fluorosis, blue line, and low caries index are presented because theyare in correlation with the mines, rocks and minerals of the area of Lavrion. This study isdedicated to the pioneer scientists in Greece and abroad for their efforts and studies.

Athens 2004. The challenges for Public Health

P DAMASKINOS, I LAMBADAKIS*

Evangelismos General Hospital, Athens, Greece.

The aim of the study is to focus on the medical planning for the Athens 2004 Olympic andParalympic Games through the experience of the previous events in Atlanta 1996 and Sydney2000 Summer Olympics and Winter Olympics in Salt Lake 2002. Planning for Olympic Games isin one sense unique. It involves deploying resources (human, logistic and material) on a scalealmost unprecedented in peacetime. (Stiel D, Trethowan P, Vance N, MJA 1997; 167:593). It isessential to realise that the public health experience during the Games in other cities, and thelessons learnt should be useful in planning for such a major event in Athens 2004. Effectivemechanisms to protect and monitor athletes, visitors and citizens should be operating during theGames. The public health preparations should focus not only on the medical emergencies,trauma or communicable disease surveillance but also on other aspects i.e. co-ordination of abig number of volunteers with the ability and the experience to handle cases with multinationalpatients. The facilities of such medical centers should be planned to be adequate to handle a bignumber of cases and to ease the operational and administration processes. The health andwelfare of the participating sportsmen and women is paramount for successful competition andthis must include oral health. (Soler B, Batchelor PA, Sheiham A, Int. Dent J 1994; 44:44-48).The planning, the stragedy and the operational aspects of public health programs, emergencymedical care and disaster preparedness in Athens will help not only in the organisationalchallenges but also in the enhancement of Public Health in Greece.

Adaptation of young and adolescents to lingualorthodontic treatment

P KANARELIS*, M KARAMOLEGOU

Athens, Greece.

The objective of this study is the comparison between adolescents and adults adaptation tolingual orthodontic treatment. Lingual orthodontic treatment is being practiced since the eightiesbut the patients were exclusively adults. The aspect was that adolescents would have tongueirritation, speech problems and bad oral hygiene. Lately, that opinion has proved wrong and the

irritation, speech problems and bad oral hygiene. Lately, that opinion has proved wrong and thefact is that most of the adolescents have a satisfied, if not excellent, adaptation to lingualorthodontic treatment. That fact came of a questionnaire, which was filled in by 25 adolescents(13-18 years old) and 35 adults (19-57 years old). All of them were under orthodontic treatmentwith lingual brackets and they were examined once a month during their orthodontic treatment.All that lingual orthodontic treatments lasted approximately two years. The results of the studyproved that adolescents had less problems than adults. Actually, adolescents could adjust theirspeech to the new condition in an extremely short period of time, contrary to adults thatmanaged to adjust their speech after a day or more. Additionally, after frequent clinicalinspections to all the patients, the conclusion was that adolescents had less tongue irritationproblems than adults. On the other hand, there was no significant differences betweenadolescents and adults' oral hygiene. The conclusion is that there is no limitation to adolescentsto take an orthodontic treatment with lingual brackets. The benefits of lingual orthodontictreatment to a young person is a great smile with no visible brackets and great self-confidence.

Oral microbial profile in head - neck cancer patientsreceiving xerostomia producing radiotherapy

C H PANAGOPOULOS, M NAKOU*, T ATHANASOULI

Dept. of Preventive and Comm. Dentistry and Microbiol. Laboratory of Periodontology, DentalSchool University of Athens, Greece.

This study was performed to assess the effects of radiation-induced xerostomia on thecomposition of the oral microflora in 10 head-neck cancer patients. Unstimulated mixed salivasamples were taken from all patients three times in a four week period, before irradiation(baseline - week 0) and at 2nd and 4th week. Whole saliva flow rates were determined by themethod of Bucher et al. (1988). Samples of mixed saliva were collected for microbiologicalanalysis. The saliva samples were diluted and appropriate dilutions were spread on plates withnon selective and selective media. The plates were incubated in the appropriate atmospheres.Identification of bacteria were performed to genus and species level. After identification therelative number of individual bacterial species were calculated. Results The mean unstimulatedsalivary flow rate fell from 0.51 ml/min before treatment, to 0.22 ml/min and 0.09 ml/min aftertreatment. The total cfu/ml in all samples were relatively unchanged while qualitative changeswere detected. Microorganisms isolated at the base line were almost similar to that of thenormal oral flora. In the 2nd week, pronounced changes in the percentages and in the isolationfrequencies were found towards a highly acidogenic flora (A. odontolyticus, Lactobacilli spp., S.mutans), while beneficial microflora, such as Veillonella spp., Neisseria spp.etc, was observedas well. Furthermore, exogenous flora was detected. Much higher concentrations wereobserved in the third sampling period (W 4) concerning the cariogenic as well as the exogenousflora. It is concluded that an oral health preventive program towards the acidogenic andexogenous flora should be applied to these patients.

Soft-tissue tumors of the mouth at a Hospital DentalDepartment

F ZERVOU-VALVI*, A PARASI, S PAPANIKOLAOU, E VALVIS, AMITSOPOULOS

Regional General Hospital of Nikea-Piraeus "St. Panteleimoin"; University of Athens, School ofDentistry, Greece.

This study aimed to analyse the cases with soft-tissue tumors of the mouth presented at theDental Department of a General Hospital in Greece. Material and methods For this purpose thepatient records of this Department were analysed over the recent 9-year-period starting from1/4/1993, when the Stomatological Clinics of this Department started to accept patients officially.This study included only cases with tumors and tumor-like lesions presented either asemergency cases or after a fixed appointment and examined by the same dentist, who hadtrained in Stomatology. Cases with epulis fissuratum and cyst of eruption were excluded.Altogether 176 cases were included. Results The analysis showed that such tumours weremore common in women (60%) than among men (40%) and in persons over 40 years old(64%). The analysis of 85 out of these tumors in which a biopsy was performed showed thefollowing: 1. The lower lip was the site of predilection (25%). 2. The majority of these tumourswere small, up to one cm (85%). 3. The histological examination showed that most of them(97.6%) were benign with irritation fibromas being the commonest ones (40%), followed bypyogenic granulomas and mucoceles. Only half (47%) of the patients presented within the firstyear after they had noticed the existence of the tumour. We conclude that most of the soft-tissue tumours of the mouth are benign. However, histological examination is necessaryfor the final diagnosis.